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In its full-color, fifth edition, Mary Townsend's Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice is still the most clearly written text on the subject. The stress/adaptation model remains the conceptual framework for the delivery of nursing care, providing a foundation of psychiatric mental health nursing knowledge to the student. New to this edition is an increased coverage of the biological causes of disease. Selected DSM-IV-TR disorders, such as schizophrenia, anxiety, and mood disorders, will include graphic brain illustrations and boxed information on psychobiological aspects of the disorder and its treatment, including the reasons specific medications can cause certain side effects.

UNIT ONE Basic Concepts in Psychiatric / Mental Health Nursing

The Concept of Stress Adaptation

3

(10)

Stress as a Biological Response

4

(2)

Stress as an Environmental Event

6

(1)

Stress as a Transaction Between the Individual and the Environment

6

(2)

Precipitating Event

6

(1)

Individual's Perception of the Event

6

(1)

Predisposing Factors

7

(1)

Stress Management

8

(1)

Adaptive Coping Strategies

8

(1)

Summary

9

(2)

Review Questions

11

(1)

References

12

(1)

Classical References

12

(1)

Mental Health/Mental Illness: Historical and Theoretical Concepts

13

(20)

Historical Overview of Psychiatirc Care

14

(1)

Mental Health

15

(1)

Mental Illness

16

(1)

Psychological Adaptation to Stress

17

(7)

Anxiety

17

(2)

Behavioral Adaptation Responses to Anxiety

19

(4)

Grief

23

(1)

Stages of Grief

23

(1)

Anticipatory Grief

23

(1)

Resolution

23

(1)

Maladaptive Grief Responses

24

(1)

Mental Health/Mental Illness Continuum

24

(1)

The DSM-IV-TR Multiaxial Evaluation System

24

(1)

Summary

25

(2)

Review Questions

27

(2)

References

29

(1)

Classical References

29

(4)

UNIT TWO Foundations for Psychiatric/Mental Health Nursing

Theoretical Models of Personality Development

33

(17)

Psychoanalytic Theory

34

(2)

Structure of the Personality

34

(1)

Topography of the Mind

34

(1)

Dynamics of the Personality

35

(1)

Freud's Stages of Personality Development

35

(1)

Relevance of Psychoanalytic Theory to Nursing Practice

36

(1)

Interpersonal Theory

36

(2)

Sullivan's Stages of Personality Development

37

(1)

Relevance of Interpersonal Theory to Nursing Practice

37

(1)

Theory of Psychosocial Development

38

(2)

Erikson's Stages of Personality Development

38

(2)

Relevance of Psychosocial Development Theory to Nursing Practice

40

(1)

Theory of Object Relations

40

(2)

Phase I: The Autistic Phase (Birth to 1 Month)

41

(1)

Phase II: The Symbiotic Phase (1 to 5 Months)

41

(1)

Phase III: Separation-Individuation (5 to 36 Months)

41

(1)

Cognitive Development Theory

42

(1)

Stage 1: Sensorimotor (Birth to 2 Years)

42

(1)

Stage 2: Preoperational (2 to 6 Years)

42

(1)

Stage 3: Concrete Operations (6 to 12 Years)

42

(1)

Stage 4: Formal Operations (12 to 15+ Years)

43

(1)

Relevance of Cognitive Development Theory to Nursing Practice

43

(1)

Theory of Moral Development

43

(1)

Level I: Preconventional Level (Prominent from Ages 4 to 10 Years)

43

(1)

Level II: Conventional Level (Prominent from Ages 10 to 13 Years and into Adulthood)

44

(1)

Level III: Postconventional Level (Can Occur from Adolescence Onward)

44

(1)

Relevance of Moral Development Theory to Nursing Practice

44

(1)

A Nursing Model---Hildegard E. Peplau

44

(3)

Peplau's Stages of Personality Development

45

(2)

Relevance of Peplau's Model to Nursing Practice

47

(1)

Summary

47

(1)

Review Questions

48

(1)

References

49

(1)

Classical References

49

(1)

Concepts of Psychobiology

50

(25)

The Nervous System: An Anatomical Review

51

(11)

The Brain

51

(4)

Nerve Tissue

55

(3)

Autonomic Nervous System

58

(1)

Neurotransmitters

58

(4)

Neuroenocrinology

62

(6)

Pituitary Gland

63

(3)

Circadian Rhythms

66

(1)

Sleep

67

(1)

Genetics

68

(3)

Psychoimmunology

71

(1)

Normal Immune Response

71

(1)

Implications for Nursing

71

(1)

Summary

72

(1)

Review Questions

73

(1)

References

74

(1)

Ethical and Legal Issues in Psychiatric/Mental Health Nursing

75

(14)

Ethical Considerations

76

(4)

Theoretical Perspectives

76

(1)

Ethical Dilemmas

77

(1)

Ethical Principles

77

(1)

A Model for Making Ethical Decisions

78

(1)

Ethical Issues in Psychiatric/Mental Health Nursing

79

(1)

Legal Considerations

80

(6)

Nurse Practice Acts

80

(1)

Types of Law

81

(1)

Classifications Within Statutory and Common Law

81

(1)

Legal Issues in Psychiatric/Mental Health Nursing

82

(1)

Commitment Issues

83

(2)

Nursing Liability

85

(1)

Summary

86

(1)

Review Questions

87

(1)

References

88

(1)

Cultural Concepts Relevant to Psychiatric/Mental Health Nursing

89

(18)

Introduction

89

(1)

How do Cultures Differ?

90

(1)

Communication

90

(1)

Space

90

(1)

Social Organization

90

(1)

Time

90

(1)

Environmental Control

91

(1)

Biological Variations

91

(1)

Application of the Nursing Process

91

(8)

Background Assessment Data

91

(5)

Culture-Bound Syndromes

96

(1)

Diagnosis/Outcome Identification

96

(1)

Planning/Implementation

96

(3)

Evaluation

99

(1)

Summary

99

(2)

Review Questions

101

(1)

References

102

(1)

Classical Reference

103

(4)

UNIT THREE Therapeutic Approaches in Psychiatric Nursing Care

Relationship Development

107

(11)

Role of the Psychiatric Nurse

108

(1)

Dynamics of a Therapeutic Nurse-Client Relationship

108

(3)

Therapeutic Use of Self

109

(1)

Gaining Self-Awareness

109

(1)

The Johari Window

110

(1)

Conditions Essential to Development of a Therapeutic Relationship

111

(2)

Rapport

111

(1)

Trust

111

(1)

Respect

112

(1)

Genuineness

112

(1)

Empathy

113

(1)

Phases of a Therapeutic Nurse-Client Relationship

113

(2)

The Preinteraction Phase

114

(1)

The Orientation (Introductory) Phase

114

(1)

The Working Phase

114

(1)

The Termination Phase

115

(1)

Summary

115

(1)

Review Questions

116

(1)

References

116

(1)

Classical References

117

(1)

Therapeutic Communication

118

(13)

What Is Communication?

119

(1)

The Impact of Preexisting Conditions

119

(2)

Values, Attitudes, and Beliefs

119

(1)

Culture or Religion

120

(1)

Social Status

120

(1)

Gender

120

(1)

Age or Developmental Level

120

(1)

Environment in Which the Transaction Takes Place

120

(1)

Nonverbal Communication

121

(2)

Physical Appearance and Dress

121

(1)

Body Movement and Posture

121

(1)

Touch

121

(1)

Facial Expressions

122

(1)

Eye Behavior

122

(1)

Vocal Cues, or Paralanguage

122

(1)

Therapeutic Communication Techniques

123

(1)

Nontherapeutic Communication Techniques

124

(1)

Active Listening

124

(2)

Process Recordings

126

(1)

Feedback

126

(2)

Summary

128

(1)

Review Questions

129

(1)

References

130

(1)

Classical References

130

(1)

The Nursing Process in Psychiatric/Mental Health Nursing

131

(20)

The Nursing Process

132

(8)

Definition

132

(1)

Standards of Care

132

(8)

Why Nursing Diagnosis?

140

(2)

Nursing Case Management

142

(2)

Critical Pathways of Care

143

(1)

Applying the Nursing Process in the Psychiatric Setting

144

(1)

Concept Mapping

145

(1)

Documentation of the Nursing Process

145

(4)

Problem-Oriented Recording

147

(1)

Focus Charting

147

(1)

The PIE Method

148

(1)

Summary

149

(1)

Review Questions

150

(1)

References

150

(1)

Therapeutic Groups

151

(11)

Functions of a Group

152

(1)

Types of Groups

152

(1)

Task Groups

152

(1)

Teaching Groups

152

(1)

Supportive/Therapeutic Groups

152

(1)

Self-Help Groups

153

(1)

Physical Conditions That Influence Group Dynamics

153

(1)

Seating

153

(1)

Size

153

(1)

Membership

153

(1)

Curative Factors

153

(1)

Phases of Group Development

154

(1)

Phase I. Initial or Orientation Phase

154

(1)

Phase II. Middle or Working Phase

154

(1)

Phase III. Final or Termination Phase

155

(1)

Leadership Styles

155

(1)

Autocratic

155

(1)

Democratic

155

(1)

Laissez-Faire

155

(1)

Member Roles

156

(1)

Psychodrama

156

(1)

The Role of the Nurse in Group Therapy

156

(1)

Summary

157

(2)

Review Questions

159

(2)

References

161

(1)

Classical References

161

(1)

Intervention with Families

162

(22)

Stages of Family Development

163

(2)

Stage I. The Single Young Adult

164

(1)

Stage II. The Newly Married Couple

164

(1)

Stage III. The Family with Young Children

164

(1)

Stage IV. The Family with Adolescents

164

(1)

Stage V. The Family Launching Grown Children

164

(1)

Stage VI. The Family in Later Life

165

(1)

Major Variations

165

(1)

Divorce

165

(1)

Remarriage

165

(1)

Cultural Variations

165

(1)

Family Functioning

166

(5)

Communication

167

(1)

Self-Concept Reinforcement

168

(1)

Family Members' Expectations

168

(1)

Handling Differences

169

(1)

Family Interactional Patterns

170

(1)

Family Climate

170

(1)

Therapeutic Modalities with Families

171

(6)

The Family as a System

171

(2)

The Structural Model

173

(1)

The Strategic Model

174

(2)

The Evolution of Family Therapy

176

(1)

The Nursing Process

177

(4)

Assessment

177

(3)

Diagnosis

180

(1)

Outcome Identification

180

(1)

Planning/Implementation

180

(1)

Evaluation

181

(1)

Summary

181

(1)

Review Questions

182

(1)

References

183

(1)

Classical References

183

(1)

Milieu Therapy---The Therapeutic Community

184

(9)

Milieu, Defined

184

(1)

Current Status of the Therapeutic Community

185

(1)

Basic Assumptions

185

(1)

Conditions That Promote a Therapeutic Community

185

(2)

The Program of Therapeutic Community

187

(1)

The Role of the Nurse

188

(1)

Summary

189

(2)

Review Questions

191

(1)

References

192

(1)

Classical References

192

(1)

Crisis Intervention

193

(14)

Characteristics of a Crisis

193

(1)

Phases in the Development of a Crisis

194

(1)

Types of Crises

195

(2)

Class 1: Dispositional Crises

195

(1)

Class 2: Crises of Anticipated Life Transitions

196

(1)

Class 3: Crises Resulting from Traumatic Stress

196

(1)

Class 4: Maturational/Developmental Crises

196

(1)

Class 5: Crises Reflecting Psychopathology

196

(1)

Class 6: Psychiatric Emergencies

197

(1)

Crisis Intervention

197

(1)

Phases of Crisis Intervention: The Role of the Nurse

197

(2)

Phase 1. Assessment

198

(1)

Phase 2. Planning of Therapeutic Intervention

198

(1)

Phase 3. Intervention

198

(1)

Phase 4. Evaluation of Crisis Resolution and Anticipatory Planning

198

(1)

Disaster Nursing

199

(1)

Application of the Nursing Process

199

(5)

Background Assessment Data

199

(1)

Nursing Diagnoses/Outcome Identification

199

(1)

Planning/Implementation

199

(1)

Evaluation

199

(5)

Summary

204

(1)

Review Questions

205

(1)

References

206

(1)

Classical References

206

(1)

Relaxation Therapy

207

(10)

The Stress Epidemic

207

(1)

Physiological, Cognitive, and Behavioral Manifestations of Relaxation

208

(2)

Methods of Achieving Relaxation

210

(3)

Deep Breathing Exercises

210

(1)

Progressive Relaxation

210

(1)

Modified (or Passive) Progressive Relaxation

211

(1)

Meditation

212

(1)

Mental Imagery

212

(1)

Biofeedback

212

(1)

Physical Exercise

213

(1)

The Role of the Nurse in Relaxation Therapy

213

(1)

Assessment

213

(1)

Diagnosis

214

(1)

Outcome Identification/Implementation

214

(1)

Evaluation

214

(1)

Summary

214

(2)

Review Questions

216

(1)

References

216

(1)

Assertiveness Training

217

(11)

Assertive Communication

218

(1)

Basic Human Rights

218

(1)

Response Patterns

218

(2)

Nonassertive Behavior

218

(1)

Assertive Behavior

219

(1)

Aggressive Behavior

219

(1)

Passive-Aggressive Behavior

219

(1)

Behavioral Components of Assertive Behavior

220

(1)

Techniques that Promote Assertive Behavior

221

(1)

Thought-Stopping Techniques Method

222

(1)

Role of the Nurse

222

(3)

Assessment

222

(1)

Diagnosis

223

(1)

Outcome Identification/Implementation

223

(2)

Evaluation

225

(1)

Summary

225

(1)

Review Questions

226

(1)

References

227

(1)

Promoting Self-Esteem

228

(12)

Components of Self-Concept

229

(1)

Physical Self or Body Image

229

(1)

Personal Identity

229

(1)

Self-Esteem

229

(1)

The Development of Self-Esteem

229

(2)

Developmental Progression of the Self-Esteem Through the Life Span

230

(1)

The Manifestations of Low Self-Esteem

231

(2)

Focal Stimuli

231

(1)

Contextual Stimuli

231

(1)

Residual Stimuli

232

(1)

Symptoms of Low Self-Esteem

232

(1)

Boundaries

233

(1)

Boundary Pliancy

233

(1)

Establishing Boundaries

234

(1)

The Nursing Process

234

(3)

Assessment

234

(1)

Diagnosis/Outcome Identification

234

(1)

Outcome Criteria

235

(1)

Planning/Implementation

235

(1)

Evaluation

235

(2)

Summary

237

(1)

Review Questions

238

(1)

References

239

(1)

Classical References

239

(1)

Anger/Aggression Management

240

(10)

Anger and Aggression, Defined

241

(1)

Predisposing Factors to Anger and Aggression

242

(1)

Modeling

242

(1)

Operant Conditioning

242

(1)

Neurophysiological Disorders

242

(1)

Biochemical Factors

242

(1)

Socioeconomic Factors

242

(1)

Environmental Factors

242

(1)

The Nursing Process

243

(3)

Assessment

243

(1)

Diagnosis/Outcome Identification

244

(1)

Planning/Implementation

244

(2)

Evaluation

246

(1)

Summary

246

(2)

Review Questions

248

(1)

References

249

(1)

The Suicidal Client

250

(15)

Historical Perspectives

250

(1)

Epidemiological Factors

251

(1)

Risk Factors

251

(2)

Marital Status

251

(1)

Gender

251

(1)

Age

252

(1)

Religion

252

(1)

Socioeconomic Status

252

(1)

Ethnicity

253

(1)

Other Risk Factors

253

(1)

Predisposing Factors: Theories of Suicide

253

(1)

Psychological Theories

253

(1)

Sociological Theory

254

(1)

Biological Theories

254

(1)

Application of the Nursing Process with the Suicidal Client

254

(7)

Assessment

254

(2)

Diagnosis/Outcome Identification

256

(1)

Planning/Implementation

256

(4)

Evaluation

260

(1)

Summary

261

(1)

Review Questions

262

(1)

References

263

(1)

Classical References

264

(1)

Behavior Therapy

265

(9)

Classical Conditioning

266

(1)

Operant Conditioning

266

(1)

Techniques for Modifying Client Behavior

267

(2)

Shaping

267

(1)

Modeling

267

(1)

Premack Principle

268

(1)

Extinction

268

(1)

Contingency Contracting

268

(1)

Token Economy

268

(1)

Time Out

268

(1)

Reciprocal Inhibition

268

(1)

Overt Sensitization

268

(1)

Covert Sensitization

269

(1)

Systematic Desensitization

269

(1)

Flooding

269

(1)

Role of the Nurse in Behavior Therapy

269

(2)

Summary

271

(1)

Review Questions

272

(1)

References

273

(1)

Classical References

273

(1)

Cognitive Therapy

274

(11)

Historical Background

275

(1)

Indications for Cognitive Therapy

275

(1)

Goals and Principles of Cognitive Therapy

275

(1)

Basic Concepts

276

(2)

Automatic Thoughts

276

(1)

Schemas (Core Beliefs)

277

(1)

Techniques of Cognitive Therapy

278

(1)

Didactic (Educational) Aspects

278

(1)

Cognitive Techniques

278

(1)

Behavioral Interventions

279

(1)

Role of the Nurse in Cognitive Therapy

279

(3)

Summary

282

(1)

Review Questions

283

(1)

References

284

(1)

Classical References

284

(1)

Psychopharmacology

285

(29)

Historical Perspectives

286

(1)

How Do Psychotropics Work?

286

(1)

Applying the Nursing Process in Psychopharmacological Therapy

287

(23)

Antianxiety Agents

287

(4)

Antidepressants

291

(5)

Mood-stabilizing Agents

296

(5)

Antipsychotic Agents

301

(5)

Sedative-Hypnotics

306

(2)

Agents for Attention-Deficit/Hyperactivity Disorder (ADHD)

308

(2)

Summary

310

(2)

Review Questions

312

(1)

References

313

(1)

Electroconvulsive Therapy

314

(8)

Electroconvulsive Therapy, Defined

315

(1)

Historical Perspectives

315

(1)

Indications

316

(1)

Major Depression

316

(1)

Mania

316

(1)

Schizophrenia

316

(1)

Other Conditions

316

(1)

Contraindications

316

(1)

Mechanism of Action

316

(1)

Side Effects

316

(1)

Risks Associated with Electroconvulsive Therapy

317

(1)

Mortality

317

(1)

Permanent Memory Loss

317

(1)

Brain Damage

317

(1)

The Role of the Nurse in Electroconvulsive Therapy

317

(2)

Assessment

317

(1)

Diagnosis/Outcome Identification

317

(1)

Planning/Implementation

317

(2)

Evaluation

319

(1)

Summary

319

(1)

Review Questions

320

(1)

References

321

(1)

Complementary Therapies

322

(15)

Commonalities and Contrasts

324

(1)

Types of Complementary Therapies

324

(10)

Herbal Medicine

324

(1)

Acupressure and Acupuncture

325

(2)

Diet and Nutrition

327

(4)

Chiropractic Medicine

331

(1)

Therapeutic Touch and Massage

332

(1)

Yoga

333

(1)

Pet Therapy

333

(1)

Summary

334

(1)

Review Questions

335

(1)

References

335

(2)

Client Education

337

(18)

Historical Perspectives

338

(1)

Theories of Teaching and Learning

339

(1)

Behaviorist Theory

339

(1)

Cognitive Theory

339

(1)

Humanistic Theory

339

(1)

Domains of Learning

340

(1)

Affective Domain

340

(1)

Cognitive Domain

340

(1)

Psychomotor Domain

340

(1)

Age and Developmental Considerations

340

(2)

The Adult Learner

340

(1)

Teaching Children and Adolescents

341

(1)

Teaching the Elderly

341

(1)

The Nursing Process in Client Education

342

(5)

Assessment

342

(2)

Nursing Diagnosis

344

(1)

Outcome Identification

344

(1)

Planning/Implementation

344

(2)

Evaluation

346

(1)

Documentation of Client Education

347

(1)

Summary

348

(1)

Review Questions

349

(1)

References

350

(1)

Classical References

351

(4)

UNIT FOUR NURSING CARE OF CLIENTS WITH ALTERATIONS IN PSYCHOSOCIAL ADAPTATION

Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence